Horizontal or transverse (intra-alveolar) root fracture is a rare injury in permanent teeth, comprising only 0.5% to 7% of all traumatic injuries. This injury involves the periodontal ligament, cementum, dentin and dental pulp. Depending on the level of the fracture line, the clinician may employ vari-ous treatment modalities to promote healing and tooth survival. Sisodia from the Postgraduate Institute of Medical Education and Research and Manjunath from JSS Dental College and Hospital, India, reported several case studies that showed how changes in technique allowed for conservative management of horizontal root fractures that occurred at different levels.
A 29-year-old woman presented with a complaint of pain, swell-ing and mobility (grade II) in her upper right front tooth (#8), following a traumatic injury 1 day prior. Clinically, #8 appeared to be displaced occlusally and was tender to percussion and palpation. An occlusal radiograph showed slight buccolingual displacement. A periapical radiograph showed the level of the fracture was at the junction of the middle and apical one-third.
While the patient was under local anesthesia, the coronal segment was repositioned with finger pressure, and the reduction was confirmed radiographically. A nonrigid composite twisted ligature wire splint was placed. An emergency pulp extirpation was done using barbed broach and 3% sodium hypochlorite irrigation. The apical fragment was not negotiated. Working length was determined radiographically and positioned 18 mm at the apical-most end of the coronal fragment, after which access was restored. Conventional technique was used to clean and shape the coronal fragment. Obturation was done using lateral cold compaction with gutta-percha and sealer. The splint was retained for 12 weeks. At the 12-month recall appointment, the patient was asymptomatic, and the periapical radiograph showed no root resorption defects or visible radiolucencies either at the fracture line or at the root apex.
A 30-year-old woman presented with a loose upper anterior tooth #8, the result of a fall 2 days prior. No his-tory of pain was reported. On examination, tooth #8 had grade I mobility and was slightly extruded. The periapical radiograph revealed the presence of a horizontal root fracture. The coronal segment was gently repositioned, and a semirigid splint was placed using a nickel—titanium wire and composite. The tooth was relieved from occlusion, and postoperative instructions were given.
After 3 weeks the patient was recalled, and the tooth responded positively to heat, cold and electric sensibility testing. At the 3-month follow-up, the patient was asymptomatic. The splint was removed after 6 months. No periapical changes were revealed in the follow-up radiograph. The fracture line was clearly visible, but no rounding of edges was noted, indicating that healing may have occurred by bone and connective tissue deposition. Pulp vitality was reassessed at 3 months, 6 months and 1 year using all 3 techniques, and normal pulp reactions were elicited. Horizontal root fracture that follows a traumatic injury should not be considered an indication for extraction.
This case series highlighted the conservative management of horizontal root fractures associated with both necrotic and vital fragments. Depending on the combination of the location of the fracture line and displacement of the fractured segment, differing techniques may be selected for optimal management. Conservative nonsurgical management of horizontal root fractures allows for both an esthetic and economical treatment alternative.
Sisodia N, Manjunath MK. Conservative management of horizontal root fracture–a case series. J Clin Diagn Res 2015;9: ZD04-ZD06.